Danish Diabetes Patients Face Gaps in Mental Health Support

A significant number of patients with diabetes in Denmark said they faced emotional distress and did not get the mental health support they needed, researchers reported.

In a survey-based study, nearly one in five people with diabetes in Denmark reported distress, stating that diabetes takes up “too much of their daily life,” according to Soren E. Skovlund, of the Steno Diabetes Center North Denmark at Aalborg University Hospital.

In over 9,000 patients with diabetes, 36% said they did not get enough mental health support to deal with the emotional impacts of living with diabetes, Skovlund said in a presentation at the American Diabetes Association (ADA) 2020 virtual meeting.

“Negative psychological impact with diabetes is common and associated with important gaps in person-centered care, and access to that in Denmark,” Skovlund said, adding that people who were out of work, had more health complications, or treated type 2 diabetes with insulin were more likely to face negative psychological effects.

“This is not an uncommon pattern, that people taking insulin are more negatively affected psychologically,” Skovlund said. A key indication of this research was the need to monitor and improve access to patient-centered care, especially among subgroups of diabetes patients that are vulnerable to mental health impacts, he stated.

Skovlund and colleagues conducted an online, national survey to characterize the need for psychological care among diabetes patients in Denmark. They emailed survey invites to nearly 39,000 members of the Danish Diabetes Association, both patients and caregivers. Surveys had around 40 questions, and required 10-15 minutes to complete.

More than 9,000 people with diabetes completed the survey as did 781 caregivers. Of the people with diabetes, around a quarter had type 1 diabetes and 71% had type 2. Approximately half of the respondents were women, and a majority were between ages 60 and 79. A third of the survey respondents had a bachelor’s degree, which was significantly higher than the general population, and there was representation from all regions of Denmark.

Of all survey respondents with diabetes, 19% said that diabetes “takes up too much of daily life” and 23% worried about complications. Nearly a fifth of diabetics said they had not been referred to a psychologist, but wished they had been offered a referral.

Patients that needed a referral to a mental health professional were likely to be less confident contacting a healthcare provider, received less coping support from the healthcare system, and faced higher levels of distress. Female patients were more than twice as likely as men to feel like they needed a psychologist.

When asked about areas of healthcare improvement, 36% of patients said they wanted better access to, and reimbursement for, the latest diabetes technologies and medications. Other main areas of healthcare improvement included access to providers with adequate diabetes knowledge, and help thriving in relation to thoughts or worries about diabetes.

Type 2 diabetes patients that did not take insulin had lower levels of distress, better quality of life, and lesser need for a psychologist referral compared with type 2 patients being treated with insulin or type 1 diabetes patients, the authors found.

Skovlund stated that the study could have been limited by the generalizability of the survey sample versus the general population. The next survey-based study will aim to have a larger sample size, he said.